Published online Jul 27, 2019. doi: 10.4254/wjh.v11.i7.586
Peer-review started: April 23, 2019
First decision: June 5, 2019
Revised: June 19, 2019
Accepted: July 4, 2019
Article in press: July 5, 2019
Published online: July 27, 2019
Processing time: 95 Days and 5 Hours
Acute liver failure (ALF) is a rare clinical syndrome with varying aetiologies based on geographic location. This condition is associated with high morbidity and mortality, and emergency liver transplantation is often life-saving.
In Australia, published data from 1988-2001 demonstrated that paracetamol toxicity was the major cause of ALF, followed by non-A non-B hepatitis. An updated analysis of aetiologies and outcomes in an Australian context is therefore required.
This study aimed to provide a description of the aetiologies and outcomes of acute liver failure presenting to a large Australian liver transplant centre. We also aimed to describe changes over the past thirty years since the availability of liver transplantation for this condition.
This is a retrospective cohort study of all patients admitted to the Victorian Liver Transplant Unit from 2001-2017. Data were compared to previous published series from the unit from 1988-2001, and as continuous data, to assess changes in aetiologies and outcomes over the past 30 years.
Paracetamol toxicity accounted for half of all cases of ALF, with a rise in the incidence of this condition over the past 30 years. Despite this observation, rates of liver transplantation for this condition are low at 4%, with an excellent overall survival. Rates of emergency liver transplantation were highest in indeterminate hepatitis and non-paracetamol drug induced liver injury. Transplant-free survival improved in this cohort compared to the historical cohort, however there was no significant change in overall survival.
Paracetamol represents the major cause of ALF in South-Eastern Australia with a concerning rise in its incidence over the past 30 years. Transplant-free survival has improved but remains low for ALF due to non-paracetamol causes.
This study shows a concerning rise in the incidence of paracetamol induced ALF in Australia, raising important questions regarding awareness and public health strategies to curb this rise. Larger multi-centre studies are required to confirm this observation. Transplant-free survival improved in this population similar to reports from other large international series, highlighting advances in supportive care.